Robot Assisted Radical Cystectomy Outcomes in Micropapillary and Plasmacytoid Variants RARC in variant pathology
Urology Journal,
Vol. 17 No. 6 (2020),
9 January 2021
,
Page 607-613
https://doi.org/10.22037/uj.v17i6.6446
Abstract
Purpose: To compare the patients who underwent robot assisted radical cystectomy (RARC) and extended pelvic lymph node dissection (EPLND) and whose pathology result was reported as micropapillary variant (MV), plasmacytoid variant (PV) and pure urothelial carcinoma (PUC).
Materials and Methods: The data of 133 patients who underwent RARC and EPLND with the postoperative pathology results reported as MV, PV and PUC were analyzed. According to the postoperative pathology results, patients were divided into two groups in initial analyses as variant pathologies group (n=14) and PUC group (n=119). In secondary analyses, patients were divided into three groups as MV group (n=7), PV group (n=7) and PUC group (n=119). The operative data, oncologic outcomes and complications were compared between the groups.
Results: Median operation time and estimated blood loss were significantly increased in variant pathologies group (P <0.001 and P = .001, respectively). The postoperative pathological T stage, positive surgical margin rate and lymph node involvement were also significantly increased in variant pathologies (P = .001, P = 0.004, P <0.001, respectively). Kaplan-Meier analysis revealed significant decrease in OS and CSS times in PV group compared to PUC group (P = .048 and P = .016, respectively).
Conclusion: MV and PV are rarely seen variant pathologies with higher pathological T stages. RARC is a minimally invasive surgical technique that can be performed successfully by an experienced surgical team with low morbidity rates and similar oncological results, even in challenging cases.
- cystectomy, micropapillary urothelial carcinoma, plasmacytoid, robotic surgical procedures, urinary bladder neoplasms
How to Cite
References
2- Wasco MJ, Daignault S, Zhang Y, et al. Urothelial carcinoma with divergent histologic differentiation (mixed histologic features) predicts the presence of locally advanced bladder cancer when detected at transurethral resection. Urology. 2007;70:69-74.
3- Cai T, Tiscione D, Verze P, et al. Concordance and clinical significance of uncommon variants of bladder urothelial carcinoma in transurethral resection and radical cystectomy specimens. Urology. 2014;84:1141-6.
4- Moschini M, D'Andrea D, Korn S, et al. Characteristics and clinical significance of histological variants of bladder cancer. Nat Rev Urol. 2017;14:651-668.
5-Devrim T, Atac F, Altunkaya C, Ozbek A, Ozdemir G, Eryol M. Rare Plasmacytoid Urothelial Carcinoma of the Bladder: Two Case Reports. Urol J. 2019;16:86-8.
6- Amin MB, Ro JY, el-Sharkawy T, et al. Micropapillary variant of transitional cell carcinoma of the urinary bladder. Histologic pattern resembling ovarian papillary serous carcinoma. Am J Surg Pathol. 1994;18:1224-32.
7- Guo CC, Dadhania V, Zhang L, et al. Gene Expression Profile of the Clinically Aggressive Micropapillary Variant of Bladder Cancer. Eur Urol. 2016;70:611-20.
8- Watts KE, Hansel DE. Emerging concepts in micropapillary urothelial carcinoma. Adv Anat Pathol. 2010;17:182-6.
9- Moschini M, Dell'Oglio P, Luciano' R, et al. Incidence and effect of variant histology on oncological outcomes in patients with bladder cancer treated with radical cystectomy. Urol Oncol. 2017;35:335-41.
10- Willis DL, Porten SP, Kamat AM. Should histologic variants alter definitive treatment of bladder cancer?. Curr Opin Urol. 2013;23:435-43.
11- Gill I, Cacciamani G. LBA3 the changing face of urologic oncologic surgery from 2000‐2018 (63 141 patients) impact of robotics. J Urol 2018;199:577–8.
12- Raza SJ, Wilson T, Peabody JO, et al. Long-term oncologic outcomes following robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium. Eur Urol. 2015;68:721-8.
13- Leow JJ, Reese SW, Jiang W, et al. Propensity-matched comparison of morbidity and costs of open and robot-assisted radical cystectomies: a contemporary population-based analysis in the United States. Eur Urol. 2014;66:569-76.
14- Collins JW, Sooriakumaran P, Sanchez-Salas R, et al. Robot-assisted radical cystectomy with intracorporeal neobladder diversion: The Karolinska experience. Indian J Urol. 2014;30:307-13.
15- Keck B, Wach S, Stoehr R, et al. Plasmacytoid variant of bladder cancer defines patients with poor prognosis if treated with cystectomy and adjuvant cisplatin-based chemotherapy. BMC Cancer. 2013;13:71.
16- Sui W, Matulay JT, James MB, et al. Micropapillary Bladder Cancer: Insights from the National Cancer Database. Bladder Cancer. 2016;2:415-23.
17- Fairey AS, Daneshmand S, Wang L, et al. Impact of micropapillary urothelial carcinoma variant histology on survival after radical cystectomy. Urol Oncol. 2014;32:110-6.
18- Li Q, Assel M, Benfante NE, et al. The Impact of Plasmacytoid Variant Histology on the Survival of Patients with Urothelial Carcinoma of Bladder after Radical Cystectomy. Eur Urol Focus. 2019;5:104-8.
19- Kaimakliotis HZ, Monn MF, Cary KC, et al. Plasmacytoid variant urothelial bladder cancer: is it time to update the treatment paradigm?. Urol Oncol. 2014;32:833-8.
20- Cockerill PA, Cheville JC, Boorjian SA, et al. Outcomes Following Radical Cystectomy for Plasmacytoid Urothelial Carcinoma: Defining the Need for Improved Local Cancer Control. Urology. 2017;102:143-7.
- Abstract Viewed: 73 times
- Pdf/6446 Downloaded: 49 times